DUPLEX-DOPPLER EVALUATION OF THE EFFECTS OF PROPRANOLOL AND ISOSORBIDE-5-MONONITRATE ON PORTAL FLOW AND SPLANCHNIC ARTERIAL CIRCULATION IN CIRRHOSIS

Background: A decrease in portal now is an important pharmacological e ffect of drugs used for the prophylaxis of variceal bleeding. Aim: To assess the acute and chronic effects of propranolol, and the effect of the acute addition of isosorbide-5-mononitrate, on splanchnic circula tion. Methods: Measurements of portal blood flow volume (PBFV) and of Doppler ultrasound pulsatility index of the superior mesenteric, femor al and interlobar renal arteries were performed in 10 cirrhotic patien ts with varices at baseline, 90 min after propranolol or placebo, afte r 30 days of chronic propranolol treatment and 45 min after the additi on of isosorbide-5-mononitrate. Results: The mean PBFV was significant ly lower at all times than at baseline, with the greatest mean percent age decrease achieved after the addition of isosorbide-5-mononitrate ( greater than or equal to 20% in all patients), Acute changes, however, did not predict the chronic effects in many patients. Isosorbide-5-mo nonitrate significantly increased the mesenteric and femoral pulsatili ty indices, whereas no significant change was observed in the kidney, Conclusions: Propranolol significantly decreases PBFV, but chronic eff ects cannot be reliably predicted by the acute change. All patients ac hieved a decrease in PBFV of greater than or equal to 20% after the ac ute addition of isosorbide-5-mononitrate to chronic propranolol treatm ent.